Provider Demographics
NPI:1487722674
Name:RIVERVIEW CLINIC PSC
Entity type:Organization
Organization Name:RIVERVIEW CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-723-7771
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1023
Mailing Address - Country:US
Mailing Address - Phone:606-723-7771
Mailing Address - Fax:606-723-4364
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1023
Practice Address - Country:US
Practice Address - Phone:606-723-7771
Practice Address - Fax:606-723-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001130Medicaid
KY35001130Medicaid
KY183875Medicare ID - Type UnspecifiedRIVERBEND GOVERNMENT